Kentucky's health departments are working on changes, to adapt to changing times

By Melissa Patrick
Kentucky Health News

Health departments across Kentucky come in all shapes and sizes, and typically work independently from each other to serve the specific needs of their community within their budgets. But to deal with changes in the health-care system, the Kentucky Health Department Association is working on a strategic plan that will bring even more changes to the departments and the people they serve.

The plan will either “succeed or health departments will be privatized; this is our choice,” said Georgia Heise, district director of Northern Kentucky's Three Rivers Health Department and current president of the National Association of County and City Health Officials.

She discussed the plan and the state's health needs at the recent fall meeting of the Friedell Committee for Health System Transformation in Lexington.

One of the biggest changes in Kentucky's health departments is a move away from clinical care toward population health, Heise said. Departments are funded for clinical care, but they were never intended to take care of the sick, contrary to public perception; and Kentucky's shift to managed-care Medicaid no longer makes it feasible for health departments to provide clinical services, she said.

Heise noted that Kentucky's health status is 45th in the nation, so the first priority of the plan is to improve it. She told the Friedell Committee that this goal is timely, since it coincides with Gov. Steve Beshear’s "kyhealthnow" goals for 2019.

Prevention through population health is the key, but prevention takes more than just educating the public; there must be political and social will, Heise said. There are also organizational obstacles.

She said local health departments have spent lots of money just being told what to do, while the health of Kentuckians just got worse. A new strategy will use a data-driven approach toward solutions and require smart goal statements, attaching responsibility to tasks and measuring everything.

The health departments want to develop a shared vision with the state Department for Public Health, which oversees them. “It does us no good to be at odds,” Heise said.

Other goals include serving as a communication tool for private and nonprofit public-health partners, and to assist with local public-health advocacy for all branches of Kentucky government.

The plan also calls for changing laws that govern health departments. “Current statutory obligations do not represent the purpose and scope of public health,” Heise said, calling the laws dated, vague and hard to understand. She said that often there is no consensus about the requirements for a health department, but they are working on that.

Heise said there are limited resources to fulfill the required mandates, and there will be no new money. “We have to do better with what we have,” she said. Kentucky already ranks 15th in per-capita spending for health care among the states.

Americans do need to worry about Ebola: not about daily risk, but about the future if it is not contained, expert says

The Ebola virus isn't a risk to Americans now, but will be "down the road" if the epidemic is not contained, says a crisis communication consultant who's been working for decades on how people and government officials respond to disease outbreaks.

Peter Sandman assured Nancy Shute of NPR that the risk to Americans does not approach any of the current hype, saying that "even if we have 10 Ebola cases a month," the U.S. can handle it.

The real risk is in the future, Sandman said. If the epidemic in West Africa is not placed under control, "a lot of sparks fly and ignite epidemics in other parts of the world" that lack health systems to handle it.

Sandman said it's normal to personalize and localize a new worry, but he would rather see Americans worry about the larger risk and work to do something about it. He also suggested that the people who are telling Americans to stop worrying should instead use this as a "teachable moment."

"If they succeed in getting people to stop worrying, they will regret it, because there's a lot to worry about it," he said. "Calming us down shouldn't be a goal."

Sandman offers four suggestions to stop the "sparks" from flying:
1. Put pressure on the government to push harder on vaccine research.
2. Make a personal contribution or urge the government to contribute toward "spark suppression."
3. Volunteer, either with your time or money.
4. Tell the CDC that you don't want 20 CDC experts in New York, you want 20 CDC experts in Nigeria to help get ready to put out the next spark and the one after that and the one after that.

"You have reason to worry that your daily life a year or two from now could be significantly worse if Ebola is all over the world," he told Shute. "And you have reason to work to prevent that, and reason to prepare for it. But what should you do in your daily life now to protect yourself against catching Ebola, assuming you're not a health care worker with an Ebola patient? Absolutely nothing. The risk to the U.S. isn't now, it's down the road."

As for the recent decisions by governors who are trying to impose quarantines on returning health-care workers, which drew open disagreement from the CDC and the White House, Sandman said, "There's certainly a case to be made that quarantine is excessive, that active monitoring would be good enough. But it seems to me to be a pretty open debate on whether quarantine is excessive or appropriate, and it depends on how cautious you want to be. Saying that the science proves incontrovertibly that quarantine is wrong — it's bad communication and it's bad science."

As of October 31, New York,  New Jersey Maine, Georgia, Illinois, California, Connecticut, Michigan, Florida, Delaware, Minnesota and Texas have varying policies on Ebola quarantines, with other states like Alaska and Kentucky still working on their policies, reports Julie Watson of the Lexington Herald-Leader.

"Kentucky officials are still hammering out an Ebola protocol but said it would likely be unnecessary given the small number of people who arrive to the state from affected countries," Watson reports.

Collaboration, telemedicine save lives in rural Kentucky

Many rural women in Appalachia can now have their babies closer to home thanks to a partnership between Appalachian Regional HealthCare and UK HealthCare.

UK HealthCare women's health providers are now based at permanent community clinics in Morehead, Georgetown and Hazard, says a University of Kentucky news release. Prenatal emergencies are still transferred by air ambulance to the UK Chandler Hospital, but full-time obstetricians, telehealth and a partnership with ARH is allowing most women to deliver closer to home.

A Breathitt County mom, Elma Thorpe, shared her story about how Dr. James Dawson, one of two doctors based at the UK HealthCare Women's Clinic in Hazard saved her life and her newborn son's life in November 2012.

At 36 weeks pregnant, Thorpe had stomach pains and thought she was going into labor. She went immediately to the hospital and was admitted to the emergency department at Appalachian Regional HealthCare Medical Center in Hazard. Her regular doctor was on vacation, so the on-call obstetrician Dr. James Dawson, one of two doctors based at the women's clinic, stepped in to deliver Thorpe's baby.

While waiting to be taken to the labor and delivery department, Thorpe developed a placental abruption, which occurs when the placenta prematurely breaks away from the wall of the uterus and was causing bleeding from the womb. That cut off the baby's oxygen supply, and Dawson feared that the baby would die inside the womb before he was able to deliver. He also knew Thorpe was in danger from losing a high volume of blood.

"With some emergencies, you have several minutes or an hour, but this was one where we had only a few minutes," Dawson said. He and the ARH medical team performed an emergency Cesarean section to deliver baby Nicholas and then successfully worked to stop Thorpe's bleeding.

UK HealthCare's Women's Health in Hazard employs two full-time obstetricians with the intent to keep women closer to their home for prenatal care and delivery, even when emergencies arise, UKNow reports.

Dawson and colleague Dr. Misty Thompson live and work in the Appalachian community they serve. A partnership between UK and ARH allows them to be on-call for deliveries and emergencies, and provide women's health services at health departments in surrounding counties.

Obstetricians in Hazard also have access to the latest ultrasound technology and consultations with UK specialists in Lexington through telemedicine if they partner with UKHealthCare.

Dr. Wendy Hansen, chair of UK's Department of Obstetrics and Gynecology, said these collaborative resources and support "will improve the level of care for women in every part of Kentucky" and will also "help recruit doctors to an historically underserved area that struggles to attract providers."

Doctors' offices full; many patients worry their common cold is one of the serious illnesses recently reported in the news

Doctor's offices are busier than usual this time of year not only because it's cold and flu season, but also because of an increased worry patients have that they might have one of the  more serious illnesses reported in the news like enterovirus D68 or Ebola, Elizabeth Renter reports for Fox News.

Dr. Sameer Maroof, a family physician at Doctors Express in Cary, N.C., told Renter that his office "had seen increase in the number of patients battling cold-like symptoms," and that some were"concerned that it could be a serious illness, such as the respiratory condition enterovirus D68."

So, what are the chances they have a serious illness? Most Americans get the common cold two or three times a year, Renter reports. While enterovirus D68, a respiratory virus with symptoms that range from mild to severe, has infected a little over 1,000 people since mid-August, with the number of infections expected to decline throughout the fall, according to the Centers for Disease Control and Prevention.

The problem is that these illnesses are closely related and have similar symptoms: runny nose, body aches, cough and respiratory problems. The flu also shares these symptoms, but add chills, fever and sore throat, Renter writes.

As for the flu, 5 to 20 percent of Americans get the seasonal flu each year, according to the CDC, but unlike the cold and enterovirus D68, the flu can be avoided because there is a flu vaccination available.

And the likelihood that you have Ebola is virtually nonexistent. The CDC has confirmed three cases of Ebola in the U.S. and you must have direct contact with the body fluid of someone with Ebola to contract it. The virus can cause diarrhea, vomiting, heavy perspiration and unexplained bruising.

So, if you have the symptoms of the common cold, it is likely you have the common cold, Renter writes. She said it's time to see the doctor if:
1. You are wheezing or having difficulty breathing.
2. You are part of an at-risk population like smokers or those with compromised immune systems.
3. You have persistent vomiting.
4. You have children with severe allergies or asthma.
5. You have symptoms lasting more than seven days.

"If patients are unsure whether their illness warrants a doctor’s visit, they should err on the side of caution," Maroof told Renter.

Study finds Tylenol and rest not best remedy for an aching back; movement, breathing and a strong body is the answer

Tylenol and rest as a cure for back pain is a thing of the past, instead the preferred treatment is to keep moving, according to a news release from the Saint Louis University Medical Center.

Seventy-five percent of people experience at least one episode of back pain in their lifetime and Chris Sebelski, DPT and associate professor of physical therapy and athletic training atSaint Louis University, says that researchers still struggle with understanding what causes it and how to treat it,

And to add to this confusion, a study released earlier this year by Australian researchers found that acetaminophen, brand name Tylenol, appears to make no difference in helping patients manage back pain, according to the release.

“It may be that acetaminophen helps but doesn’t completely eliminate back pain, or it may work for some people and some injuries, but not others,” Sebelski said in the release. The answer is to "broaden our approach to include more than Tylenol and a few days rest."

America's sedentary lifestyle which often includes desk jobs, hours in front of a screen and lack of physical activity is a recipe for stiff muscles and achy backs.

“Instead of sitting at your desk for hours, change positions, stand for 20 minutes, or go for a walk and talk to someone. Movement will keep you healthy and allow you to adjust," Sebelski said in the release.

And the level of movement doesn't have to be a huge time or energy commitment; "you don't have to join a gym," he said.

People with back pain should also work work on strengthening the whole body, Sebelski says. Strong legs, limber hips and a strong trunk "will keep you from overtaxing lower back muscles to compensate for weakness elsewhere in the body."

Sebelski also emphasises the importance of breathing which surprisingly also strengthens groups of muscles within your trunk.

“Deep breathing really activates key muscles in your trunk,” Sebelski said. “Talk. Laugh out loud. Do cardio. Do yoga. Do things that force you to breathe. This will help your back stay healthy.”

The best medicine for an aching back, says Sebelski, is "active rest."

“There’s no such thing as just ‘rest,’ Sebelski said. “At rest, muscles weaken; moving builds strength. Think about it in terms of alternating movement and active rest.

“Even after an injury, while you don’t put yourself at risk by pushing yourself too hard before you’re ready, you also don’t just go to bed. You do what you can do. Even something as simple as walking offers significant benefits.”